Use Of Topical Analgesics Research Articles

The validity of topical drug therapy for otitis media with effusion

Otitis media with effusion is difficult to diagnose, since the course of the disease is mostly asymptomatic, while the initial stage of the disease is very similar to Eustachiitis or the pre-perforative stage of acute otitis media. At this stage, dysfunction of the auditory tube and negative pressure in the tympanic cavity creates the conditions for the production of transudate, which clinically, in addition to hearing loss, is accompanied by soreness, a feeling of congestion, pressure, fluid transfusion in the ear. When conducting local medical procedures, they are primarily guided by the condition of the mucous membrane of the eustachian tube, nasopharynx and nasal cavity, but changes in the eardrum are no less important. Thus, the use of topical analgesics with an anti-inflammatory effect becomes no less relevant in the treatment.A literature review was carried out with an analysis of scientific research data on the use of a topical combination drug that has a local anesthetic and anti-inflammatory effect in the treatment of diseases of the external and middle ear.Analysis of the literature showed that the use of lidocaine-phenazone-containing drops promotes rapid regression of the inflammation in the external auditory canal and the tympanic membrane, as well as relieving of pain. It can be used both in children (including newborns) and in adults who are suffering from otitis media but with intact tympanic membrane, including otitis media with effusion.Combined topical drugs containing lidocaine-phenazone demonstrate efficacy and safety in the treatment of catarrhal and otitis media with effusion in all age groups.

A service evaluation of pediatric oral mucosal disease experience in a tertiary joint pediatric-oral medicine clinic

<h3>Objectives</h3> The true global prevalence of pediatric oral mucosal disease has historically proved difficult to determine, based on heterogeneity and inherent limitations in study designs and a largely descriptive narrative. The 2019 World Workshop on Oral Medicine VII: Relative Frequency of Oral Mucosal Lesions in Children, a Scoping Review quantified pediatric oral mucosal disease experience globally based on pooled and region-specific data from clinical studies and biopsy reports. The aim of this investigation was to retrospectively review clinical data to compare pediatric disease experience in a tertiary joint pediatric-oral medicine clinic at the Royal National ENT and Eastman Dental Hospital, UCLH, London, UK, with published global data from the world workshop. <h3>Methods</h3> Quantitative analysis was retrospectively performed on recorded clinical data from 22 joint clinics attended between January and December 2018, with recording of patient demographic characteristics, diagnosis, investigations, and management. <h3>Results</h3> Two hundred sixty-six patients (143 males, 128 females; age range, 8 months to 18 years) were seen in 2018. Referring clinicians included general dental practitioners (n = 54; 49%), secondary care medical and dental specialties (n = 33; 30%), community dental services (n = 15; 14%), and general medical practitioners (n = 9; 8%). Medical comorbidities were noted in 62 patients (23%). Idiopathic recurrent aphthous stomatitis (n = 65; 24%,), mucocele (n = 24; 9%), oral Crohn disease/orofacial granulomatosis (n = 18; 7%), and geographic tongue (n = 11; 4%) were the most commonly presenting conditions. Malignancy was the primary diagnosis in only 1 patient (mucoepidermoid carcinoma). Investigations performed included imaging (n = 27; 11%), blood tests (n = 26; 10%), and biopsy procedures (n = 23; 9%). Management included the use of topical analgesics (n = 71; 27%), topical corticosteroids (n = 94; 35%), topical calcineurin inhibitors (n = 19; 7%), and systemic immunomodulation (n = 22; 8%). <h3>Conclusions</h3> Similarity to world workshop conclusions was noted, with a predominance of benign oral mucosal disease within this patient demographic. Roughly 1 in 10 patients required investigation by imaging, blood testing, or biopsy. Although the world workshop data represented mostly transient conditions with an infectious or traumatic etiology, within this cohort, there was a greater representation of the oral manifestations of systemic disease, which may well represent the tertiary nature of referral to this unit.

Neuropathic pain in spinal cord injury: topical analgesics as a possible treatment.

Review of the literature and semi-structured interviews. To explore the possible use of topical analgesics for the treatment of neuropathic pain (NP) in spinal cord injury (SCI). Institute for Neuropathic Pain, Soest, The Netherlands. A review was performed of studies on topical analgesics for SCI-related NP published up to May 2019. In addition, eight persons with SCI-related NP who were treated with topical analgesics were interviewed in a semi-structured interview on their experience with topical analgesics. Seven studies (five case reports and two case series) were found that evaluated the use of topical analgesics for SCI-related NP. None of the studies used a control treatment. Topical analgesics included baclofen, ketamine, lidocaine, capsaicin, and isosorbide dinitrate. All studies reported a decrease in NP over time. Persons interviewed were 49-72 years of age and all but one had an incomplete SCI. They used topical agents containing phenytoin, amitriptyline, baclofen, ketamine or loperamide. All showed a decrease in pain of at least 3 points on the 11-point numeric rating scale during this treatment. Evidence on the use of topical analgesics in SCI is scarce. Case reports, case series and interviews suggest that the use of topical analgesics can be beneficial in treating SCI-related NP. Placebo-controlled studies are required to investigate the effect of topical analgesics on SCI-related NP.

THU0347 Clinical Effectiveness of 8 % Capsaicin Dermal Patch in the Treatment of Carpal Tunnel Syndrome

BackgroundThe name of carpal tunnel syndrome (CTS) refers to a complex of symptoms resulting from the pressure exerted on the median nerve in the carpal tunnel area. CTS is the...

Capsaicinoids in the treatment of neuropathic pain: a review

The treatment of neuropathic pain is difficult. Oral pharmaceuticals have significant side effects, and treatment efficacy tends to be modest. The use of topical analgesics reduces the potential for systemic side effects and allows direct application of medications to the area of pain. The natural spicy substance, capsaicin, has historically been known for its topical use. Capsaicin, once applied to the skin, causes a brief initial sensitization followed by a prolonged desensitization of the local pain nerves. This occurs through stimulation of the transient receptor potential vanilloid-1 (TRPV1) expressing pain nerve fibers. While low-dose capsaicin has not resulted in good efficacy, the larger dose 8% topical capsaicin has had some of the best data currently available in the treatment of post-herpetic neuralgia (PHN) and other neuropathic conditions. This paper discusses the data currently existing for capsaicin 8% in the treatment of PHN. It further reviews data for the low-dose capsaicin products and the current status in the development of other capsaicinoids, e.g. resiniferotoxin, and high-concentration liquid capsaicin.

The Future of Topical Analgesics

Topically applied analgesic therapies have been used throughout history to treat a variety of patient conditions that present with pain. Before modern pharmaceuticals became readily available, mud-based emollients, salves, cold therapies, and other natural remedies were often used. Now we have effective therapies and are developing advanced topical analgesics as we learn more about the physiology and pathophysiology of pain. The use of topical analgesics may be associated with fewer patient systemic side effects than are seen with oral, parenteral, or transdermally administered agents, making the topical route of administration attractive to prescribers and patients. With further refinement of existing drugs and the development of novel agents, topical analgesics may offer relief for treating patient pain conditions that are currently challenging to treat, such as pain resulting from burns, wound debridement, and pressure ulcers. Recognizing the value of a multimodal approach, topical analgesics may offer a therapeutic option that can become part of a comprehensive treatment plan for the patient. With continued advancements in targeted drug–delivery systems, topical analgesics may be able to provide a method to prevent or reverse the phenomena of peripheral and central sensitization, or the neuroplastic changes believed to be responsible for the transition from acute to chronic pain states in patients. For those patients at risk for developing chronic pain states, such as complex regional pain syndrome, the combination of cutaneous stimulation (achieved through rubbing during application) and analgesic effects produced by the drug itself may prevent the disabling pain that often emerges during the subacute phase of disease. In summary, better utilization of currently available topical analgesics and continued research promise to ensure that topical analgesics are, and will continue to be, important tools in the treatment of patients with resistant pain.

Analgesic use in the older person

To summarize developments in analgesic use in the older person. Observational studies, reviews and a few randomized trials dealing with analgesic use in the older person have been published during the past year. Recent trials examine also pharmacological/nonpharmacological interventions, and education of older patients as well as clinicians in pain management. Under-treatment of pain remains a major concern in community-dwelling or institutionalized older persons, especially with dementia. An increased awareness of pain and palliative pain management in the older person is present throughout the literature. Age-related factors affect the safety and efficacy of the analgesic treatment and pharmacological aspects are often underlined, especially when impaired cognition and frailty are present. The use of topical analgesics, well tolerated in older persons, allows reduction of concomitant treatments and of adverse events. Optimizing analgesic use in older patients is carried out by exploring motivations and attitudes of the patients, by analysing barriers and practices of clinicians and by setting up structured educational nursing interventions. Although a larger number of older persons are included in studies, prospective and large-scale trials are needed in this vulnerable population characterized by a high variability and heterogeneity.

5% lidocaine-medicated plaster vs other relevant interventions and placebo for post-herpetic neuralgia (PHN): a systematic review

Several pharmacological treatments are used to manage post-herpetic neuralgia (PHN). The use of topical analgesics, such as 5% lidocaine-medicated plaster (5% LMP), may be preferable to systemic treatments in that they are formulated to produce a local pain relieving effect with minimal systemic absorption. However, direct head-to-head comparisons are relatively few, and a rigorous assessment of the relative efficacy and safety of the various treatment options is lacking. The objective of this study was to compare 5% LMP for the relief of PHN with other relevant interventions and placebo. Six databases were searched up to May 2010. Quantitative methods for data synthesis were used, and a network meta-analysis was conducted. Twenty unique studies (32 publications) were included. Placebo-controlled studies showed 5% LMP to be effective in providing pain relief and reducing allodynia while adverse event rates were generally low. A comparison between 5% LMP and pregabalin indicated the non-inferiority of 5% LMP for pain reduction and showed greater improvement of quality of life for 5% LMP. Adverse events (AE) were significantly fewer with 5% LMP. In the network meta-analysis, only 5% LMP and gabapentin were associated with a greater change in pain from baseline than placebo [-15.50 (95% CI -18.85 to -12.16) and -7.56 (95% CI -12.52 to -2.59) respectively]. 5% LMP was shown to be more effective than capsaicin [-16.45 (95% CI -20.04 to -12.86)], gabapentin [-7.95 (95% CI -13.29 to -2.61)] and pregabalin [-13.45 (95% CI -19.19 to -7.71)]. For pain relief, two comparators were more effective than placebo [mean pain relief, gabapentin: 32.77 (95% CI 15.57-49.97); 5% LMP: 26.77 (95% CI 9.11-44.43)]. 5% LMP was shown to be comparable to gabapentin [-6.00 (95% CI -25.32-13.32)]. The results suggest that 5% LMP and gabapentin have similar effects on pain relief and that 5% LMP is more effective than capsaicin and pregabalin (change in pain from baseline). Topical agents, such as 5% LMP, are associated with fewer and less clinically significant AE than is the case for systemic agents. However, small numbers, and limited size and quality of included studies should be taken into account. Further studies are needed.

EUROPEAN PAIN MANAGEMENT DISCUSSION FORUM

ABSTRACTQueries from European physicians about analgesic pharmacotherapy and responses from the author are presented. The topics addressed in this issue are the potential effect of nonsteroidal anti-inflammatory drugs on bone fractures, use of topical analgesics for osteoarthritis pain in a patient who is nonadherent with oral pharmacotherapy, and the use of transcutaneous nerve stimulation for cancer pain management.

Topical Agents for the Management of Musculoskeletal Pain

The recent recognition of the magnitude of cardiovascular risk of both nonselective nonsteroidal anti-inflammatory drugs and COX-2 selective inhibitors, in addition to the persistent concerns about the use of opioids, has brought increased attention to nonsystemic, topical analgesics. These agents have a favorable safety profile and there is increasing evidence indicating their efficacy for a variety of pain disorders. The use of topical analgesics in the treatment of the most prevalent musculoskeletal pain syndromes is described, with a focus on mechanisms for drug delivery and clinical trials data.

Selling comfort: A survey of interventions for needle procedures in a pediatric hospital

Needle procedures are a necessary component of the treatment of hospitalized children. However, for many children they can be both painful and distressing. There was concern among the nurses at our pediatric hospital that we were not adequately controlling pain from needle procedures. We were interested in obtaining more information about the incidence and types of needle procedures and the current use of topical analgesics. A survey was designed to describe the frequency, type, time to complete, and perceived ease of needle procedures. The use of topical anesthetics and other comfort measures was also examined. The most common needle procedures performed were venipunctures for blood work, followed by intravenous cannulations, capillary sticks, port-a-cath access, and intramuscular injections. In total, 387 procedures were performed over a 23-day period. The majority of the procedures were perceived as easy, and the modal time to complete the procedures was 5 minutes. A topical anesthetic was used for 74 procedures (i.e., 19%), and the majority of these procedures were performed on the medical day unit with oncology patients. Results of the survey provided information about the day-to-day practice of needle procedures in order to identify both the supports and the barriers to providing these procedures atraumatically. Examining needle procedures within a framework of atraumatic care broadened our perspective and enabled us to integrate the use of topical anesthetics as just one of a number of strategies to minimize the pain and distress associated with needle procedures.

A review of the use of topical analgesics for myofascial pain.

Numerous treatment strategies for myofascial pain syndrome are available, including physical therapy, behavioral pain management techniques, acupuncture, various types of injections, and the use of various pharmacotherapeutic approaches. The use of topical analgesics for myofascial pain syndrome is the focus of this review. The use of topical analgesics in other painful states is also reviewed.

Widespread use of topical analgesics in the US

Widespread use of topical analgesics in the US